Strengthening the Swiss health system by improving organizational health literacy: a practice-approach

Abstract Issue Healthcare organizations represent vital points of contact and disseminators for people to find, understand, assess, and apply health information, and may thereby strengthen people's health literacy (HL). From a system perspective, healthcare organizations provide essential practices and structures to foster population health beyond their medical-based services. Description of the problem Despite increasing research on the promising role of organizational health literacy (OHL) the current Swiss healthcare system provides insufficient support for healthcare organizations to address HL. In response, the Careum Foundation in Zurich recently launched a Center for Health Literacy to promote OHL - among other HL initiatives. A first step was a practice-oriented collaboration project with the Department of Health of the canton of Zurich, which started in 2019 to assess, implement, and improve HL in primary care organizations. Therefore, a self-assessment tool for OHL is being developed, implemented, and evaluated. In addition, the center started to shed light on HL in Switzerland, on HL and necessary competencies of health professionals. Moreover, it is investing in communication and expertise on OHL, and developing first ideas regarding health literate hospitals. Results A first systematic evaluation of the self-assessment tool has demonstrated a significant potential to improve OHL, organizational development, and teambuilding processes in healthcare organizations. Connected through (inter)national networks, the Center for Health Literacy launches a practice approach to understand OHL as both medium and outcome of a health literate population. Lessons We have learned that practice-oriented OHL initiatives can provide promising approaches to strengthen both population health and organizational development processes.


Background:
Limited health literacy (LHL) is associated with faster kidney deterioration. To maintain kidney function, health care professionals (HCPs) promote self-management. However, in chronic kidney disease (CKD) care organizations, patients with LHL report multiple communication and self-management barriers. The need for health literacy responsive organizations, and multi-component interventions targeted at patients and HCPs, is recognized. We aimed to determine the objectives and strategies of such an intervention, and to co-create and evaluate it. Methods: First, we performed a longitudinal qualitative study among CKD patients with LHL (n = 24) and HCPs (n = 37) from general practices and nephrology clinics to assess needs and barriers, and to identify promising intervention objectives. Second, we included patients (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) in an Intervention Mapping (IM) process to co-create and evaluate the intervention.

Results:
Grip on Your Kidneys (GoYK) addresses the competences of patients with LHL to self-manage CKD on the long-term, and the communication competences of patients and HCPs. Based upon patients' preferences, GoYK encompasses a visually attractive website and brochures to optimize self-management and a card to contribute to consultations. With HCPs, we developed a training to optimize their competences to support patients with LHL. Evaluation revealed the intervention was useful, comprehensive and fitting needs.

Conclusions:
Mapping the needs of CKD patients and HCPs, combined with a process of intervention co-creation, resulted in a multicomponent, positively evaluated intervention. Implementation of this type of interventions in organizations is promising to improve care for patients with LHL. However, the effectiveness of these interventions requires further assessment.

Issue:
Healthcare organizations represent vital points of contact and disseminators for people to find, understand, assess, and apply health information, and may thereby strengthen people's health literacy (HL). From a system perspective, healthcare organizations provide essential practices and structures to foster population health beyond their medical-based services. Description of the problem: Despite increasing research on the promising role of organizational health literacy (OHL) the current Swiss healthcare system provides insufficient support for healthcare organizations to address HL. In response, the Careum Foundation in Zurich recently launched a Center for Health Literacy to promote OHL -among other HL initiatives. A first step was a practice-oriented collaboration project with the Department of Health of the canton of Zurich, which started in 2019 to assess, implement, and improve HL in primary care organizations. Therefore, a self-assessment tool for OHL is being developed, implemented, and evaluated. In addition, the center started to shed light on HL in Switzerland, on HL and necessary competencies of health professionals. Moreover, it is investing in communication and expertise on OHL, and developing first ideas regarding health literate hospitals.

Results:
A first systematic evaluation of the self-assessment tool has demonstrated a significant potential to improve OHL, organizational development, and teambuilding processes in healthcare organizations. Connected through (inter)national networks, the Center for Health Literacy launches a practice approach to understand OHL as both medium and outcome of a health literate population.

Lessons:
We have learned that practice-oriented OHL initiatives can provide promising approaches to strengthen both population health and organizational development processes.

Background:
Health care facilities (i.e., hospitals, care facilities and integration assistance) play an important role in providing health-related information and strengthening health literacy (HL) of patients/clients, staff and at the organizational level. The project ''Development of Health Literacy in Health Care Facilities (EwiKo)' aims at implementing tools to promote and strengthen organizational health literacy (OHL) in health care institutions in Germany. Objectives are 1) to assess needs for strengthening OHL in pilot facilities and 2) to examine factors that are beneficial to strengthen OHL in health care facilities. Methods: N = 6 pilot institutions (n = 2 hospitals, n = 2 care homes for elderly people, n = 2 facilities for people with disabilities) and their members of the ''working groups on HL'' filled in a selfassessment tool to assess the level of OHL, accompanied by iii154 European Journal of Public Health, Volume 32 Supplement 3, 2022